University Of Pittsburgh

Dapartemen Of Otolaryngologi
Muscle Tension Dysphonia

Understanding the Disorder

Muscle Tension Dysphonia (MTD)
The term “muscle tension dysphonia” is a general term
for an imbalance in the coordination of the muscles and
breathing patterns needed to create voice. This
imbalance can be seen without any anatomical
abnormality (primary MTD) or in the presence of an
anatomical abnormality (secondary MTD). In the case of
secondary MTD, the muscle tension is thought to be the
body’s natural compensatory process to adjust for the
vocal injury. This section will discuss primary MTD.

Stress and Anxiety

Primary MTD can be associated with stress and anxiety.
Recent research has shown that under periods of stress,
the muscles that control the voice box become tense.
Periods of prolonged muscle tension in the voice box can
lead to an incoordination of the vocal control system.

Causes
Primary MTD often occurs following an upper respiratory
illness, such the cold or flu. In the case of an upper
respiratory tract infection, the muscular imbalance is not
thought to be connected to stress and anxiety.
Significant stressful life events, such as the loss of a
loved one, can cause muscle tension dysphonia as well.

Symptoms
Muscle tension dysphonia is a highly variable condition.
The most common symptom of primary MTD is a change
in voice quality, ranging from mild to severe and it is
often associated with pain or discomfort while speaking.
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Dapartemen Of Otolaryngologi
The voice can be affected during speaking, singing or
both. Often, hoarseness will be associated with an
increased effort to talk and subsequent fatigue or tiring
of the voice with continued use.

Common Symptoms Associated with MTD

 Vocal fatigue

 Unreliable voice

 Low, gravely voice

 Voice breaks

 Airy or breathy voice

 Inability to sing

 Hoarse and rough quality

 Extra force needed for loud voice

 Vocal symptoms worsen with stress

 Inconsistent voice

 Voice sometimes returns to normal

Diagnosis
How is the diagnosis of MTD made?
1. Patient History: A history of how the voice problem
started and an evaluation of voice and speaking
behaviors are important steps in the diagnosis of primary
MTD.
2. Speech-Language Pathology Evaluation
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Dapartemen Of Otolaryngologi
 Examination by a speech-language pathologist is
very important in the diagnosis of muscle tension
dysphonia.

 Improvement in voice through trial voice therapy

techniques is key to determining that the vocal
disorder is due to a muscular imbalance.

 Acoustic and aerodynamic measurements are also

valuable assessment tools to determine normal voice
and breathing behaviors.

3. Laryngoscopy and Stroboscopy

 Careful examination of the vocal folds is essential

for making the diagnosis of primary MTD. It is a
diagnosis of exclusion; therefore, careful
examination of the vocal folds is necessary to rule
out anatomical abnormalities.

 Flexible laryngoscopy allows the clinicians to

observe some muscular patterns during speaking.

 Stroboscopy allows the examiner to assess the

mucosal wave as a marker for vocal fold vibration.

4. Investigation for Other Associated Abnormalities

 The diagnostic process should also focus on looking

for important associated factors, such as:

o Reflux

o Allergies

o Side effects of medications (e.g., diuretics and

antihistamines)

o Hormonal Imbalance
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Dapartemen Of Otolaryngologi
Treatment
Voice Therapy
Voice therapy is the gold standard treatment for primary
MTD. There are no other treatments that can restore the
muscle balance in the vocal mechanism. Voice therapy
helps the patient improve vocal symptoms through
exercises and techniques geared at improving the way
the body (muscles, lungs etc.) work together to create
voice.

Behavioral Counseling
In cases of primary MTD associated with stress or
anxiety, it can be very helpful for the patient to work with
a counselor to reduce stress in addition to completing
voice therapy.